Accuracy of subxiphoid echocardiography for assessing left ventricular size and performance.

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Abstract
No data are available comparing subxiphoid M-node echocardiography with left ventricular (LV) cineangiography, although in some patients an LV echogram can only be obtained by this approach. Patients [41] without coronary artery disease and with symmetric ventricular contraction documented by cineangiography were studied. A total of 23 patients had adequate LV echograms recorded from both the subxiphoid and standard left sternal border (LSB) transducer positions and were analyzed further. Estimations of end-diastolic volume, end-systolic volume and ejection fraction from the subxiphoid echogram compared favorably with the angiographic determinations (r [correlaton coefficient] = 0.92, 0.98 and 0.78, respectively). End-diastolic volume by subxiphoid echo averaged 138 .+-. 94 ml (SD), not statistically different from the angio volume of 135 .+-. 91 ml. Subxiphoid echo overestimated ejection fraction at 71 .+-. 15% compared with 58 .+-. 16% by angio (P < 0.001), as did the standard LSB echo technique at 69 .+-. 17% (P < 0.001). Mean LV measurements by both echo methods were nearly identical: end-diastolic dimension, subxiphoid 5.0 .+-. 1.0 cm and LSB 5.0 .+-. 1.0 cm (r = 0.94); end-systolic dimension, subxiphoid 3.3 .+-. 1.2 cm and LSB 3.4 .+-. 1.3 cm (r = 0.99); percent dimensional shortening, subxiphoid 35 .+-. 10% and LSB 34 .+-. 11% (r = 0.95); mean normalized rate of dimensional shortening, subxiphoid 1.4 .+-. 0.4 s-1 and LSB 1.3 .+-. 0.4 s-1 (r = 0.90). Subxiphoid echocardiography, like the standard LSB method, is a valid technique for assessing LV size and performance in patients without LV dyssynergy.